COMMITTEE INFORMATION. Check if this is a new name

Transcription

1 REPORT OF RECEIPTS AND EXPEND TIRES Indiana Election Commission (IC ) INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this form. For assistance in completing this form, see instructions on the reverse side. IS THIS AN AMENDMENT? Yes Eg No CFA-4) Sheet FILE NUMBER TOTAL PAGES IN ENTIRE CFA-4 REPORT COMMITTEE INFORMATION 1. Full Name of Committee (as on Statement of Organization) Committee to Elect Caleb S. Johnson Check if this is a new name 2. Acronym or Abbreviated Name (if any) 3. Committee Telephone Number ( 219 ) Mailing Address (address where all campaign finance correspondence is received) Check if this is a new address 8221 Durbin St. 5. City, State, ZIP Code Crown Point, IN Party Affiliation (if applicable) Republican CANDIDATE INFORMATION (For Candidate's Committees Only) 7. Full Name of Candidate (include any nickname) 8. Party Affiliation or If Independent Candidate Caleb S. Johnson 9. Office Sought (Include district number, if any. Not required for exploratory committee County of Residence Lake County, IN 11. Check one: TYPE OF REPORT Pre Primary D] Pre Election Annual Nomination Other FinaVDisbands Committee (tines , and 20 mat be V) Outgoing Treasurer (sonm IQ days amend Statement oforganization) 12. Reporting Period: From: 4/11/15 Through: 10/09/ Cash on hand and investments at the beginning of this reporting period. 14. Cash on hand and investments January 1, current year. CONTRIBUTIONS AND RECEIPTS (Note: these amounts include in-kind contributions and loans, as well as cash contributions.) 15a. Itemized (use Schedule A) 15b. Unitemized 15c. Add lines 15a and 15b in both columns SUBTOTAL 16. Add lines 13 and 15c in Column A and lines 14 and 15c in Column B TOTAL r, s/penditures (Note: These amounts include in-kind expytn to f; tfut1der aymenfs.) This Period co.4 tot) CONVENTION CANDIDATES ONLY Check one: Pre-Convention Post-Convention Year to Date 474,44 / 14%,?..,.>, in I 6 / sq055". VI f----* 5p3; 1 q I '1 0 1/5-. 4/ I 9 1 6,0,(04 S 1. c 5 404, 3, 0 17a. Itemized (use Schedule B) (P ' QuesliorPa du b. Unitemized 41y n 17c. Add lines 17a and 17b in both columns i3 cr, SUBTOTAL 31 `$' Vs- r> 3 3 Cp3, et X9 7A 18. Cash on hand and investments at close of this reporting period (su h.*, ilic from 16 in both columns) TOTAL q d3.,-1.2, 19. Debts OWED BY the committee (use Schedule D) 20. Debts OWED TO the committee (use Schedule E) i i 310. '17 CERTIFICATION I CERTIFY THAT I HAVE EXAMINED THIS STATEMENT. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. Signature of Treasurer Title Dale vte."-.4e Signature of Candt (if applicable) Date 12/t. fic , , 3. g el (./, c/a li / a3,q2 FOR OFFICE USE ONLY

2 Indiana Election Commission (IC ) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY INDIVIDUALS ON THIS SCHEDULE. Please type or print legtly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet. AD cumulative contributions from individuals OVER $ per contributor, within a calendar year MUST be itemized on this schedule (over $200, if regular party committee). All cumulative receipts, (such as loan proceeds and repayments, refunds, rebates, returns of deposit, proceeds from sales, interest or other income) OVER $ per contributor, within a calendar year, MUST be itemized on this schedule (over $200 if regular party committee). A contributor's occupation is required if an individual makes at least $1,000 in contributions during the calendar year. Otherwise, this is optional. (CFA-4 SCHEDULE A-1) CONTRIBUTIONS BY INDIVIDUALS Itemized Contributions and Other Receipts CONTRIBUTOR'S FULL NAME AND OCCUPATION (street, number, city. state, ZIP code) 1. Rip and Bonnie Johnson W. 77* Ave., Dyer, IN '2 Direct DATE RECEIVED 5/01/15 Interest N Loan Contributor's Occupation (if required)_general Contractor - Dad 2. Dave Bell 2820 Bristlecone Dr., ScherervIlle, IN E Direct I I I In-Kind (describe) 200 5/01/15 8/17/15 Contributor's Occupation (it required) Business manager 3. Bruce and Alison Norton 8658 Durbin Ln, Crown Point, IN C.4 Direct 200 5/01/15 8/17/15 Contributor's Occupation (/required) 4. Craig and Cindy Whaley 646 Saratoga St, Crown Point, IN Interest Loan Misc. (speciy) P 4 Direct 50 a In-Kind (describe) 150 5/01/15 8/17(15 Interest Loan Contributor's Occupation (if required) 5. Norman Renehen and Family 7509 Marshall St., Merrillville, IN /01/15 ei3 Direct a In-Kind (describe) Interest Loan Misc. (specify) Contributor's Occupation (uirequied) SUBTOTAL THIS PAGE OF SCHEDULE A $750 (Enter total on ITEM 15a of the Summary Sheet), '.7

3 _ REPORT OF RECEIPTS AND EXPENDITURES State Form 4606 (R13/11.05) Indiana Election Commission (IC ) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY INDIVIDUALS ON THIS SCHEDULE. Please type or print legibly IN BLACK INK ad information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet. All cumulative contributions from individuals OVER 5 per contributor, within a calendar year MUST be itemized on this Schedule (Over SIM if regular party committee). All cumulative receipts. (such as loan proceeds and repayments, refunds, rebates, returns of deposi; proceeds from sates, interest or other income) OVER $ per contributor, within a calendar year. MUST be itemized on this schedule (over MOO if regular party committee) A contributor's occupation is required if an individual makes at least 51,000 in contributions during the calendar year. Otherwise, this is optional. (CFA-4 SCHEDULE A-1) CONTRIBUTIONS BY INDIVIDUALS Itemized Contributions and Other Receipts FIL NUIVIr Page '3 of CONTRIBUTOR'S FULL NAME AND OCCUPATION (street, number, city, state, ZIP code) jb IA *%.. 4(99 f all m.,..3 1c l' era (.42 ft p, 1?-iti,..3"Āl V6 307? l r3 C4 Pt. MIDirect In-Kind (describe) Other Receipts. Interest Loan # I 0 0 DATE RECEIVED II' tact IV / 17/ r- Contributor's Occupation Or metier 2 (/) ; I( I' / kk Pro-Ire,.. er c e) 4 g oft' 0 r S ck.taeitiat _TV V Contributor's Occupation ('rooriked) 3. kre pt axr,.-,k e q 0 0 y H.qt top D r, 5.0 It Ca el e I We- _rit/ 1/4375 Contributor's Occupation (frecuifed) LEI...Direct Interest Loan misc. (specify) CLuirect Other Receipts II Interest Loan misc. (specify) I/ 6) A/25-11 /00 ft/..". r//7/..ri 19 ii/ / 5- S-41/5 dl 2--(A.S t- rrt 4.-1 r1-,, /I, t ( ):A i en.) C-t-r. tftbr. y TA/ / Contributor's Occupation (.freccrmr) S. &ix, r 1 0_ p I i r..- 1 /t 51 5 ra-41-01:-.,ergi CrO 4..) A Contributor's Occupation ('required) PO i A1- X'N Y6) P7 cxdirect In Kind (describe) Interest Loan tasirect Interest Loan qi & a iti6o 6705/4r1 it 0 $ S70/1/5- -5/05"-- SUBTOTAL THIS PAGE OF SCHEDULE A S 5F, x,00 (Enter total on ITEM 15a of the. Summary Sheet)

4 (CFA-4 SCHEDULE A-1) REPORT OF RECEIPTS AND EXPE IT State Form 4606 (R13/11.05),"*NCONTRIBUTIONS BY INDIVIDUALS Indiana Election Commission (IC ) Ite d Contributions and Other Receipts ' INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY INDIVIDUALS ON THIS SCHEDULE. Please tyr r print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule. see instruction on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet. Al cumulative contributions from individuals OVER S per contributor. within a calendar year MUST be itemized on this schedule (over $200. if regular party =Willed All cumulative receipts, (such as loan proceeds and lepaymonts, refunds. rebates. returns of deposit proceeds from sales, interest or other income) OVER 5 per contributor, within a calendar year. MUST be itemized on this schedule (over $26V) if regular party committee). A contributor's occupation is required if an individual makes at least $1,000 in contributions during the calendar year. Otherwise, this is optional. 1 CONTRIBUTOR'S FULL NAME AND OCCUPATION (street, number, city, state, ZIP code) 3 e (14-011ie ep 1 ir 5 t 0 & 6 m 9 D...tr- Si- 5C ktatetrttle 1 Ai (140375' itntrdibrouticions Interest Loan \ D t's' \sbb DATE RECEIVED Cleil tc Contributor's Occupation (d required) It p yi... 9,..t.....,.. k ir I- I- ollir L. "" 5-0 f e te r IA t j, r ill fi 315- Cotributions. Contributions NI Direct Oth er Receipts: 0 Interest Loan Misc. (specify) ) ' 3 *A6 c I Di )1( Contributor's Occupation (dimity') 3. if', I 4' If f 4. l'll 1 i 4( if- Contributions, &Direct In-Kind (describe) Contributor's Occupation (drequeed) 4. (.4 b 3:9 A 4 5 IYA p. va.b, ( res,,,,, c),,,c-r- Pt) Lea?in Contributor's Occupation (lrequard) i A.0 t -1, t t 1". A C-) 1111 Direct In-Kind (describe) /31) I NI interest 17g-Loan 18rect Direct Other Receipt I Wi 0 t 1 I. t i Cif 5' Sfiii/5-- VI, ( 1r Contributor's Occupation Of required) SUBTOTAL THIS PAGE OF SCHEDULE A (Enter- total on ITEM 15a of the Summary Sheet),

5 Indiana Election Commission (IC ) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY POLITICAL ACTION COMMITTEES ON THIS SCHEDULE. Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet. All cumulative contributions from political action committees OVER $ per contributor, within a calendar year MUST be itemized on this schedule (over 5200, if regular party committee). All transfers-in and in-kind contributions regardless of amount from political action committees MUST be itemized on this schedule. All cumulative receipts, (such as loan proceeds and repayments, refunds, rebates, returns of deposit, proceeds from sales, interest or other income) OVER $ per contributor, within a calendar year, MUST be Itemized on this schedule (over $200 if regular party committee). (CFA-4 SCHEDULE A-4) CONTRIBUTIONS BY POLITICAL ACTION COMMITTEES Itemized Contributions and Other Recei is 1 CONTRIBUTOR'S FULL NAME AND (street, number, city, state, ZIP code) CO ry{ en i'/- t re ta, rile' c ik Te r r y-- Fie (9.Yz, rcp -e- 4, cttel,e-1 v! /L Di V'y 75-- K.Direct III Misc. (specify) 11) od DATE RECEIVED S/( /by k $ ft. 4. IV Vi. t44 ( t 4 4/,..Direct II In-Kind (describe) *.-140 IttANr 11/ Interest Loan **C.-../ Direct Interest Loan Misc. (speci6i) 4. Direct In -Kind (describe) Interest is Loan 5. Direct Interest III Loan Misc. (specify) SUBTOTAL THIS PAGE OF SCHEDULE A $ I 1p6 00 (Enter total on ITEM 15a of the Summary Sheet) '''

6 Indiana Election Commission (IC ) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY ORGANIZATIONS OTHER THAN CORPORATIONS, LABOR ORGANIZATIONS, POLITICAL ACTION COMMITTEES AND INDIVIDUALS ON THIS SCHEDULE Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet All cumulative contributions from other entities OVER $ per contributor, within a calendar year MUST be itemized on this schedule (over 5200, it regular party committee). At transfers-in and in-kind contributions regardless of amount from candidate's, legislative caucus. and regular party committees MUST be itemized on this schedule. All cumulative receipts, (such as loan proceeds and repayments, refunds. rebates, returns of deposit, proceeds from sales, interest or other income) OVER $ per contributor, within a calendar year, MUST be itemized on this schedule (over $200 if regular party committee). (CFA-4 SCHEDULE A-5) CONTRIBUTIONS BY OTHER ORGANIZATIONS Itemized Contributions and Other Recei ts CONTRIBUTOR'S FULL NAME AND (street, number, city, state, ZIP code) ge a ta, is y, 6-tkzoi 'Vol) us (111 / 36 (4-ta MI/.,(/'6t* rai ta 5 7r 1)5 Direct. M-Kind (describe) Interest Loan f0e, DATE RECEIVED gli / 1//5 2. Direct In-Kind (describe) Interest III Loan Direct Interest Loan I. Direct is In-Kind (describe) Other Receipts : Misc. (specify). II Direct In-Kind (describe) II Interest Loan SUBTOTAL THIS PAGE OF SCHEDULE A $ (Enter total on ITEM 15a of the Summary Sheet).._...,... 0,-,, $. '' 1 4! l' -"",

7 State Form 4606 (R13/11.05) Indiana Election Commission (IC (CFA-4 SCHEDULE B) ITEMIZED EXPENDITURES INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document expenditures totaled on ITEM 17a of the FILE NUMBER Summary Sheet. All cumulative expenses paid to individuals, businesses, labor organizations and other entities OVER $ per recipient, within a calendar year MUST be itemized on this schedule (over $200, if regular party expenses, including in-kind, committee). All cumulative regardless of amount paid to political committees, (such as caucus, political action, or regular party committees) transfers-out from candidate, legislative MUST be itemized on this schedule. Page of RECIPIENT'S NAME AND MAILING ADDRESS (street, number, City, state, ZIP code) RECIPIENT'S OCCUPATION OFFICE SOUGHT Of applicable) TYPE OF EXPENDITURE and PURPOSE (be specific) DATE OF EXPENDITURE Code n I japirect In-Kind Payment of Debt ti Trn erl 'At _0.a 00ther _ Puns= 0 n I i\n.,2 13 eekc Returned Contribution 11 '7 3,5g Lri 3, 0 tf/2/(5- Code, 14- o rect In-Kind o Payment of Debt Returned Contribution 0, e 5 I. I Pre0-5,4 h5 65 rs. liat 011. i ciii3o 0 li s-if.00 // // Code k I taareot e L ;4-0 In-Kind Payment of Debt I+, 0 s'iso e),..., 4- -,-te c 0 Returned Conbibution 15-Iq Other :C_24 t 1 1 ' Pi- /kj ct 65 " VI.4, i 0. ) 0 6 // ti/5- Code 1 lit) R YI.. 4-rs - 0. A6t 6, r I el. "'*".1...fit 4-4 C c 1,,,v, e,-,i.. tie IN Y6?1.5- Code A- I a. F toet r4,, ;..., 5 - MA ; ILI ti..tp.,,..4, 1.02 E V No... II-J t I V. f port444) Ziv ' '~ ;a anima In-Kind Payment of Debt Returned Contribution Other Direct In-Kind 0 Payment of Debt o Palmed Contribution pother _ 5'0 op 5-5-D 0 0 g/ I s//5 4 3 to it -wo tofe(/,r e ck tats Code r I Direct in-kind 3-04,1,ev. p.1,1 11 va' b X.. S - - C. rev4a PO,:.1.7i I L1630? t I9-Payment of Debt Returned Contribution Other _..._ Pur pose.? ctiz.45-2., G.5" (il 17/1/.5 ::ode i Direct in-kind o Payment of Debt Returned Contribution Other SUBTOTAL THIS PAGE OF SCHEDULE B $3585,175 TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on ITEM 17a of the Summary Sheet) $ 3 / rits: v

8 Indiana Election Commission (IC ) (CFA-4 SCHEDULE D) DEBTS OWED BY THIS COMMITTEE INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. List all debts and loans regardless of the amount OWED BY the committee during the reporting period. Include all amounts owed for or to lend institutions, individuals, credit purchases, committee credit card accounts, etc. List each vendor paid by credit card issued in the name of the committee in the ENDORSER'S column. A lender's occupation is required if an individual makes loans of at least $1,000 during the calendar year. Otherwise, this is optional. CREDITOR'S OR LENDER'S NAME & MAILING ADDRESS (street ili,m1)r city, state, ZIP code) ENDORSER'S OR VENDOR'S NAME & MAILING ADDRESS 0/ any) (street, number, city. state, ZIP code) I AMOUNT NATURE OF DEBT DATE DEBT INCURRED PAID YEAR O.DATE OUTSTANDING BALANCE THIS cj,t j 0 It A 5 eaa 13.--; a, 0...h b.\ 571 Cr owsq Pe:n t rd 41470"7 LENDER S OCCUPATION f' P,, Loan q NI 5-3? V i 0.7 LENDERS OCCUPANCS1 LENDER'S OCCUPATION- i i LE ZER'S CCCUPAiNOEi LENDER'S OCCUPATION. LENDER'S OCCCVALON. LEN'DER'S OCCUPATION SUBTOTAL THIS PAGE OF SCHEDULED TOTAL OF ALL PAGES OF SCHEDULE D ON THE LAST PAGE ONLY (Enter total on ITEM 19 of the Summary Sheet) $ 1,37o.q1. i /4,6 it..7 a I/ )1V ' 7 I